Fleming chronic pain Flashcards
Do not dose over __ morphine equivalents (MME)
90
Use caution dosing over __ morphine equivalents (MME)
50
Reassess meds at least every __ months
3
Chronic pain dosing start with what?
PRN short acting opioid
add long acting opioid in dose equal to 50-75% of 24 hour PRN dose
An alternative for uncontrolled pain on current dosing is to increase long acting med by __ to __ %
15, 25
Ensure pain meds are stable for __ hours if discharging from acute setting with pain meds
24
Do opioids have a ceiling effect?
no
What is first line for osteoarthritis pain?
acetaminophen
What nsaid is preferred in the elderly?
acetaminophen
2 drug classes for adjuvant cancer pain?
steroids
bisphosphonates
4 first line agents for neuropathic pain?
gabapentin
amitriptyline
duloxetine
pregabalin
5 second line agents for neuropathic pain?
tramadol APAP/nsaids opioids topiramate oxcarbazepine
2 TCAs used as pain adjuvant Tx?
amitriptyline
nortriptyline
2 SNRIs used as pain adjuvant Tx?
duloxetine
venlafaxine
Which adjuvant SNRI is also labeled for chronic musculoskeletal pain?
duloxetine
fibromyalgia
4 anticonvulsants used for adjuvant pain?
gabapenin
pregabalin
oxcarbazepine
carbamazepine
Opioids are __ line for neuropathic pain.
a. first
b. second
b. second
What opioid is used for neuropathic pain rescue therapy?
tramadol
Do muscle relaxants have addiction potential?
yes
Muscle relaxants are preferred for __ use only
a. short
b. long
a. short
What muscle relaxant is also available in IV form?
methocarbamol
What muscle relaxant’s absorption is increased by food?
metaxalone
4 muscle relaxants:
cyclobenzaprine (Flexeril)
carisoprodol (Soma)
methocarbamol (Robin)
metaxalone (Skelaxin)
two alpha2 adrenergic agonists for pain?
clonidine
tizanidine
Which alpha 2 adrenergic agonist is used for postoperative or cancer pain, with a possible role in chronic pain or neuropathy?
clonidine
0.1mg BID
Which alpha 2 adrenergic agonist is used for pain/discomfort due to spasticity?
tizanidine
2mg TID
__ is a NMDA receptor antagonist that is typically used for anesthesia/sedation in the critical care setting
ketamine
lower doses can be used for pain
What control class is ketamine?
C-III
The best evidence for adjuvant agents is for __ pain
neuropathic
__ is the therapeutic effect of a med proportionate to the unit strength or volume. In the case of pain management, the ratio of doses or med required to provide an equivalent pain relief
potency
__ is the dose at which two different pain meds provide an approximate equivalent pain relief
equianalgesic dose
Will sedation and n/v decrease over time with opioids?
yes
2 weak full agonists?
codeine
hydrocodone
2 agents with most histamine release?
morphine
codeine
Is buprenorphine synthetic or semi-synthetic?
semi-synthetic
Which opioid has accumulation of active metabolites in renal insufficiency causing agitation, confusion, delirium?
morphine
Which opioid is dose reduced in renal dysfunction due to drug accumulation?
hydromorphone
Which opioid has an ER formulation for pts needing continuous management of mod to severe pain?
oxycodone
___ ER is approved as a stand alone formulation available through REMS program only
Zohydro
form of hydrocodone
Which opioid has BBW for respiratory depression and death in children following tonsillectomy in ultra rapid metabolizers?
codeine
Which opioid should generally not be used in opioid naive pts?
fentanyl
Which form of fentanyl is never used for acute pain?
patch
Should fentanyl dose be titrated up in the setting of acute pain?
no
Does fentanyl have serotonergic actions?
yes
caution wit MAOIs and other serotonergic drugs
Which opioid has less effects on BP than others?
fentanyl
Which opioid is 5-10 times more potent than fentanyl and is used for IV surgical analgesia?
sufentanil
Which opioid has a new sublingual formulation for use in medically supervised settings?
sufentanil
REMS program
What opioid is effective treatment for shivering?
meperidine
Which opioid metabolite can induce hyperpyrexia and/or seizures when used with MAOIs?
normeperidine
Is meperidine more or less potent than morphine?
less potent
shorter duration and greater toxicity
Which opioid is a new injection formulation?
oliceridine
potential for QT prolongation
Avoid methadone dose titrations more frequently than every __ to __ weeks
1, 2
caution with QT prolonging agents
Which opioid has IV form d/c as of April 2018?
pentazocine
Common AEs of pentazocine include __ and _
hallucination, dysphoria
Is pentazocine a full or partial agonist?
partial
PO combo product with naloxone to deter misuse
What control class is tramadol?
C-IV
Tramadol should be used with caution in pts with __ disorders
seizure
Two centrally acting alternate agents?
tramadol
tapentadol
What control class is tapentadol?
C-II
Which centrally acting alternate agetn is used for neuropathy?
tapentanol
Pts taking oral morphine __mg daily for >= 1 week are at risk of tolerance?
60
Pts taking transdermal fentanyl __ mcg/h for >= 1 week are at risk of tolerance?
25
Pts taking oral oxycodone __mg daily for >= 1 week are at risk of tolerance?
30
Pts taking oral hydromorphone __mg daily for >= 1 week are at risk of tolerance?
8
Pts taking oral oxymorphone __mg daily for >= 1 week are at risk of tolerance?
25
When accounting for incomplete cross tolerance reduce equianalgesic dose of new drug by __ to __ %
25, 50
A pt tolerant to the effect and side effects of one opioid may not be equally tolerant to the effects and side effects of another opioid
a. true
b. false
a. true
